Clarithromycin linked to risk of cardiac death
A Danish study has found that clarithromycin could increase the risk of heart problems significantly more than other antibiotics, especially among women
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Clarithromycin could increase the risk of cardiac deaths significantly more than other antibiotics, especially among women, a study published in the British Medical Journal has found. Patients on clarithromycin had a 76 per cent higher risk of cardiac death than patients on fellow macrolide roxithromycin and penicillin V, according to the Danish study of more than 5 million antibiotic courses, published on Tuesday (August 19). The study found the link between clarithromycin and heart problems was "largely attributable" to women. It stressed that the increased risk of cardiac deaths only occurred when the patients were taking courses of clarithroymcin and that past use did not have the same effect. The study analysed the effects of seven-day courses of antibiotics among Danish adults aged 40 to 74 between 1997 and 2011. Penicillin V accounted for more than 4 million of the courses, while nearly 589,000 were of roxithromycin and more than 160,000 clarithromycin. A total of 285 cardiac deaths occurred in the patients taking the antibiotics – 18 were in patients who had taken clarithromycin, 32 were in patients who took roxithromycin and 235 were in patients who took penicillin V. This indicated there were 37 cardiac deaths per million treatment courses of clarithromycin, compared to only 2 per million on the other antibiotics, found the study's authors, based in the Statens Serum Institut in Copenhagen. They also noted that 61 per cent of clarithromycin patients who died due to heart problems were female, making the risk to women higher but not statistically significant. The authors found no differences in risk among other subgroups, despite looking at age profiles, cardiac risk score and the concomitant use of cytochrome P450 3A inhibiting drugs, which metabolise macrolide antibiotics. Further research was needed to determine whether the findings should influence clinical decision-making, said the study's authors, who included a statistician, postdoctoral fellow and senior investigator. But they warned that this was "urgent" given the widespread use of macrolide antibiotics.
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